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73 Cards in this Set
- Front
- Back
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5 categories of abnormal uterine bleeding
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1. Amenorrhea
2. Ovulatory bleeding 3. Anovulatory bleeding 4. Post-coital bleeding 5. Post-menopausal bleeding |
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failure of menarche by age 14 if no secondary sex characteristics OR by 16 if secondary sex characteristics are present
most likely cause? |
anatomic disorder
primary amenorrhea |
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absence of menstruation for 6 months
cause? |
chronic anovulation
secondary amenorrhea |
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amenorrhea
causes? |
• Anatomic – present with primary amenorrhea
• Ovarian failure • Chronic anovulation – present with secondary amenorrhea • Also evaluate women who experience amenorrhea if they have no breast development by age 14 or if any sexual ambiguity or virilization is present |
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30 yo female
amenorrhea most likely cause? |
pregnancy
rule of pregnancy in women of reproductive age |
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cyclic menstrual bleeding that is excessive in time (>7days) or amount (>80mL)
cause? |
Anatomic - leimyoma, uterine polyps
Chronic anovulation like endometrial hyperplasia due to unopposed estrogen secretion menorrhagia |
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unpredictable bleeding of variable duration and amont
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Anovulatory Bleeding
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bleeding at intervals longer than 35 days
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Oligomenorrhea
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prolonged uterine bleeding that is also irregular
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Menometrorrhagia
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Post-coital bleeding
sign of? |
cervical cancer
dd: cervical erosion |
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• History of menometrorrhagia since menarche
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Coagulopathy
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what do you use to determine presence of ovulatory or anovulatory cycles
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• Basal body temperature graphs
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• Enlarged, irregular uterus
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leiomyomas
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• Symmetrically enlarged uterus
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adenomyosis or endometrial carcinoma
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atrophic and inflammatory
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vulvar and vaginal lesions, cervical polyps, and invasive lesions of cervical carcinoma
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• Velvety, friable erythematous lesion on ectocervix
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pregnancy
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what do you look for on a pap smear?
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asymptomatic intraepithelial lesions of the cervix
• Invasive ectocervical lesions • Endocervical lesions |
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ways of evaluating endometrial lining
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Endometrial Biopsy,
Pelvic Ultrasound Hysteroscopy |
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how to assess for complications in pregnancy and trophoblastic disease
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• B-hCG
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which test to evaluate adnexial masses
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• Pelvic ultrasound and laproscopy
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test to determine cause of post-coital bleeding
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• Colpscopy
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effect of hypothyroidism on bleeding?
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increase uterine bleeding
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effect of liver disease on estrogen
result? |
interferes with estrogen metabolism → bleeding
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• Blood dyscrasias and coagulation abnormalities
cause? |
o Check if patient is receiving anticoagulants or adrenal steroids
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Bleeding due to non-gynecological reasons (4)
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1. hypothyroidism
2. liver disease 3. anticoagulants/steroids 4. extreme weight loss |
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abnormal uterine bleeding
vulva and vagina |
atrophic vulvitis/vaginitis
trauma infection cancer |
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Cervix pathologies
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erosion
polyp cancer pedunculated myoma (fibroids) |
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abnormal uterine bleeding
uterus |
endometritis
hyperplasia cancer polyp adenomyosis submucous myoma oral contraceptives perforation due to IUDs pregnancy Asherman Mullerian agenesis |
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abnormal uterine bleeding
uterine/fallopian tubes |
tubal pregnancy
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abnormal uterine bleeding
ovaries |
estrogen-producing tumor
malignancies ovarian cysts |
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benefit of myomectomy
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retains childbearing ability
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abnormal uterine bleeding
protocol? |
check for:
- pregnancy - contraceptives - IUDs - hormones if no pathology, cancer, hemorrhage: - treat w/ hormones |
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complication of vigorous curettage
previous uterine surgery severe infection TB histology? |
scarring (synechiae)
destruction of basal endometrium (no proliferation & sloughing during menses) Asherman syndrome |
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amenorrhea
recurrent miscarriage uterine scarring tx? |
Hysterosalpingography
Hysteroscopic lysis of adhesions - allows precise division of bands and documentation Asherman's syndrome |
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outflow obstruction or lack of endometrium
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Mullerian agenesis
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diff b/w complete & partial mullerian agenesis
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complete: no mullerian structures at all
partial: rudimentary bulbs w/ active endometrium |
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amenorrhea
vaginal dimple |
complete mullerian agenesis
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amenorrhea
cyclic abdominal pain |
partial mullerian agenesis
(functional endometrium) |
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outflow obstruction
vaginal dimple tx? |
vaginal dilation
surgical neovagina Mayer-Rokitansky-Kuster-Hauser syndrome (Complete Mullerian Agenesis) |
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african american female
menorrhagia enlarged uterus on pelvic exam tx? |
• Hysterectomy
• Myomectomy • Uterine artery embolization • Magnetic resonance-guided focused ultrasound surgery Uterine leimyoma |
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enlarges in pregnancy
regress after menopause |
uterine leimyoma
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what test do you use to see if a uterine leimyoma is subserosal, submucosa, intramural, or pedicle?
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transvagina sonography
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45 yo female
multiple kids symmetric globular uterine enlargement menorrhagia passage of large clots increased dysmenorrhea histology? |
ectopic rests of endometrium located deep in myometrium
adenomyosis |
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ectopic rests of endometrium located deep in myometrium
tx? |
NSAIDs
hormonal contraception endometrial ablation adenomyosis |
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Cytp450 aromatase is associated with this
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adenomyosis
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• Gene translocation on chromosome 6 and 12
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polyps
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• Estrogen and progesterone
• HTN, obesity, tamoxifen histology? |
soft, fleshy mass of endometrial glands and stroma
polyps |
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mass extends out of cervical os
menorrhagia metrorrhagia post-coital bleeding |
endocervical polyps
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bleeding, but fetus is still alive
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threatened abortion
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passage of some fetal or placental tissue
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incomplete abortion
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placenta inserts over the cervical os
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placenta previa
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placenta pulls away from the uterus
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placental abruption
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colicky pain w/o bleeding in pregnancy
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abortion
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adnexial mass when palpated (corpus luteum felt)
no bleeding |
threatened abortion
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unilateral pain in lower abdominal quadrant
no bleeding Uterus tender distended tube syncope...what happened? |
tube rupture -> acute intense pain -> syncope
ectopic pregnancy |
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acute intense pain -> syncope -> prompt recovery -> bleeding continues -> less acute abdominal pain
where does the pain get referred to? why? |
shoulder after it reaches diaphragm when patient lies down from dizziness
ectopic pregnancy |
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ectopic pregnancy
besides the intense pain, what else causes syncope |
hemoperitoneum = low EABV
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positive pregnancy test
empty uterus adnexal mass by vaginal sonography |
ectopic pregnancy
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causes of post-menopausal bleeding
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exogenous hormones
tumors vaginal atrophy/lesions |
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post-menopausal bleeding
assume what? could also be what? |
endometrial cancer -> sonography, biopsy
endometrial hyperplasia/estrogen secreting ovarian tumor |
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post-menopausal bleeding
lower reproductive tract what will exam show? tx? |
vaginal atrophy
tissue w/ ecchymosis (bruise), tear tx w/ systemic estrogen therapy |
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post-menopausal bleeding
white area and cracking of skin cytology? |
immature epithelial cells
inflammation vulvar dystrophy |
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no breast development by age 14
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primary amenorrhea
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sexual ambiguity
what do you do? |
evaluate for primary amenorrhea
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chronic anovulation with estrogen present
type of hypthalamic function disorder? |
secondary
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chronic anovulation with estrogen absent
type of hypothalamic function disorder |
primary
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kallman's syndrome is assoc w/ which type of chronic anovulation
(failure of GnRH neurons to migrate to right spot in hypothalamus) |
estrogen absent
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enlarged, irregular uterus
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leimyoma
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most common indication for hysterecomy
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leimyoma
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early pregnancy complications
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threatened abortion
trophoblastic disease |
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late pregnancy complications
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placenta previa
placental abruption uterine rupture |
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inappropriately rising B-hCG
no gestational sac in uterus complex adnexal mass |
ectopic pregnancy
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abnormal bleeding in a female child
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trauma
foreign body vagina tumor (sarcoma) precocious puberty prolapsed urethra |
